The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery
The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery
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DOI：
10.1007/s11605-007-0290-0
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发表时间：
2007-11-01
影响因子：
3.2
通讯作者：
Gould, Jon C.
中科院分区：
文献类型：
--
作者：
Dholakia, Chirag;Beverstein, Gretchen;Gould, Jon C.
右美托咪定(Precedex，赫士睿，Lake Forest，IL)是一种α-2受体激动剂，具有镇静和止痛的特性。这种药物与呼吸抑制无关，尽管偶尔有很高的镇静水平。在10个月的时间里，所有接受腹腔镜减肥手术的患者在预期的手术完成前30分钟接受了右美托咪定输注(n=34)。对照组包括在紧接这10个月之前的一段时间内接受过腹腔镜减肥手术的相似数量的患者(n=37)。每组患者的所有路径和出院标准都是相同的。共有73名患者被纳入这项回顾图表。排除了两名胃旁路手术患者需要额外手术的并发症(一例出血，一例渗漏)。接受右美托咪定输注的胃旁路手术患者所需麻醉药(66 mg吗啡当量)比对照组患者少(66 mg吗啡当量)，并且在术后第1天(61%比26%出院，p=0.02)达到出院标准。所有组的生命体征和疼痛评分都是相似的。围手术期输注右美托咪定是安全的，可能有助于减少麻醉药物的需求，并减少腹腔镜减肥手术后的住院时间。在阻塞性睡眠呼吸暂停高发人群中，这可能会对患者安全产生重要影响。有必要进行一项组织良好的前瞻性、随机、双盲试验，以证实本研究所建议的右美托咪定的益处。
Dexmedetomidine (Precedex, Hospira, Lake Forest, IL) is an alpha-2 receptor agonist with sedative and analgesic sparing properties. This medication has not been associated with respiratory suppression, despite occasionally high levels of sedation. For 10 months, all patients undergoing a laparoscopic bariatric procedure received a dexmedetomidine infusion 30 min before the anticipated completion of the procedure (n=34). A control group was comprised of a similar number of patients to have had laparoscopic bariatric surgery in the time period immediately before these 10 months (n=37). All pathways and discharge criteria were identical for patients in each group. A total of 73 patients were included in this retrospective chart review. Two gastric bypass patients were excluded for complications requiring additional surgery (one bleed and one leak). Gastric bypass patients who received a dexmedetomidine infusion required fewer narcotics (66 vs 130 mg of morphine equivalents) than control patients and met discharge criteria on post-op day (POD) 1 more often (61% discharged POD 1 vs 26% discharged POD 1, p=0.02). Vital signs and pain scores were similar in all groups. Dexmedetomidine infusion perioperatively is safe and may help to minimize narcotic requirements and decrease duration of stay after laparoscopic bariatric procedures. This may have important patient safety ramifications in a patient population with a high prevalence of obstructive sleep apnea. A well-organized prospective, randomized, double-blinded trial is necessary to confirm the benefits of dexmedetomidine suggested by this study.